Zhong Jingyu, Hu Yangfan, Xing Yue, Liu Xianwei, Ge Xiang, Wang Yibin, Shi Yuping, Lu Junjie, Yang Jiarui, Song Yang, Lu Minda, Chu Jingshen, Zhang Huan, Ding Defang, Yao Weiwu
Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
Insights Imaging. 2024 Oct 9;15(1):242. doi: 10.1186/s13244-024-01829-y.
To review the evidence for clinical adoption of clear cell likelihood score (ccLS) for identifying clear cell renal cell carcinoma (ccRCC) from small renal masses (SRMs).
We distinguished the literature on ccLS for identifying ccRCC via systematic search using PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and Wanfang Data until 31 March, 2024. The risk of bias and concern on application was assessed using the modified quality assessment of diagnostic accuracy studies (QUADAS-2) tool. The level of evidence supporting the clinical adoption of ccLS for identifying ccRCC was determined based on meta-analyses.
Eight MRI studies and three CT studies were included. The risk of bias and application were mainly related to the index test and flow and timing, due to incomplete imaging protocol, unclear rating process, and inappropriate interval between imaging and surgery. The diagnostic odds ratios (95% confidence intervals) of MRI and CT ccLS were 14.69 (9.71-22.22; 6 studies, 1429 SRM, 869 ccRCC), and 5.64 (3.34-9.54; 3 studies, 296 SRM, 147 ccRCC), respectively, for identifying ccRCC from SRM. The evidence level for clinical adoption of MRI and CT ccLS were both rated as weak. MRI ccLS version 2.0 potentially has better diagnostic performance than version 1.0 (1 study, 700 SRM, 509 ccRCC). Both T2-weighted-imaging with or without fat suppression might be suitable for MRI ccLS version 2.0 (1 study, 111 SRM, 82 ccRCC).
ccLS shows promising diagnostic performance for identifying ccRCC from SRM, but the evidence for its adoption in clinical routine remains weak.
Although clear cell likelihood score (ccLS) demonstrates promising performance for detecting clear cell renal cell carcinoma, additional evidence is crucial to support its routine use as a tool for both initial diagnosis and active surveillance of small renal masses.
Clear cell likelihood score is designed for the evaluation of small renal masses. Both CT and MRI clear cell likelihood scores are accurate and efficient. More evidence is necessary for the clinical adoption of a clear cell likelihood score.
回顾关于采用透明细胞可能性评分（ccLS）从肾小肿块（SRM）中识别透明细胞肾细胞癌（ccRCC）的临床应用证据。
我们通过使用PubMed、Embase、Web of Science、中国知网和万方数据进行系统检索，甄别出截至2024年3月31日关于ccLS识别ccRCC的文献。使用改良的诊断准确性研究质量评估（QUADAS - 2）工具评估偏倚风险和应用方面的问题。基于荟萃分析确定支持临床采用ccLS识别ccRCC的证据水平。
纳入了8项MRI研究和3项CT研究。偏倚风险和应用问题主要与索引测试、流程和时间有关，原因包括成像方案不完整、评级过程不明确以及成像与手术之间的间隔不合适。对于从SRM中识别ccRCC，MRI和CT的ccLS诊断比值比（95%置信区间）分别为14.69（9.71 - 22.22；6项研究，1429个SRM，869个ccRCC）和5.64（3.34 - 9.54；3项研究，296个SRM，147个ccRCC）。MRI和CT的ccLS临床应用证据水平均被评为低。MRI的ccLS 2.0版本可能比1.0版本具有更好的诊断性能（1项研究，700个SRM，509个ccRCC）。有脂肪抑制或无脂肪抑制的T2加权成像可能都适用于MRI的ccLS 2.0版本（1项研究，111个SRM，82个ccRCC）。
ccLS在从SRM中识别ccRCC方面显示出有前景的诊断性能，但在临床常规应用中的证据仍然不足。
尽管透明细胞可能性评分（ccLS）在检测透明细胞肾细胞癌方面表现出有前景的性能，但需要更多证据来支持其作为肾小肿块初始诊断和主动监测工具的常规使用。
透明细胞可能性评分旨在评估肾小肿块。CT和MRI的透明细胞可能性评分都准确且高效。透明细胞可能性评分的临床应用需要更多证据。
